A severe maldistribution of anesthesia personnel in the United States results in suboptimal coverage of many hospitals outside larger metropolitan centers. Because of this, many nurse anesthetists and potential non-physician personnel are forced to work without access to anesthesiologists. A demonstration system is proposed in which three hospitals in Greater Cleveland are linked to the University Hospitals by laser beam two way audiovisual communication systems. The system would transmit data from an ICU and from patients under anesthesia in selected operating rooms of the participating hospitals to a monitoring station in University Hospitals. At the monitoring station a senior anesthesiologist can scan the ICU and the participating operating rooms, zoom in on details, and communicate with the non-physician anesthesia personnel. In addition to this electrocardiographic signals, auscultatory signals and pictures from patient records are transmitted to the consultant anesthesiologist at the monitoring station. Using these data the consultant can recommend therapeutic procedures. While the project will involve design, development, evaluation and demonstration of a new approach, it simultaneously will help to solve acute, severe, and important problems of health care delivery in a hard pressed hospital of the inner city in Cleveland.